How far have we come baby? The current knowledge about exposure to buprenorphine during pregnancy and lactation

Citation

Jones, H., & Johnson, R. E. (2004). How far have we come baby? The current knowledge about exposure to buprenorphine during pregnancy and lactation. (NIDA Research Monograph 184). National Institute on Drug Abuse.

Abstract

Buprenorphine, a partial mu-opioid agonist, is the most recent opioidmaintenance pharmacotherapy approved by the United Sates Food & DrugAdministration for non-pregnant patients. Given buprenorphine'savailability in both office-based practice and traditional opioidtreatment settings (i.e., methadone clinics), fetal exposures to thismedication will occur. Thus, physicians treating a pregnantopioid-dependent patient entering treatment will have several options:commence buprenorphine treatment (category C), commence methadonetreatment (category B and the only recommended medication), or provide aclosely monitored taper following stabilization on an opioid agonist.Physicians treating a pregnant patient already maintained on buprenorphinewill also have several options: discontinuing buprenorphine, transferringto methadone or continuing to buprenorphine. Current literature ofbuprenorphine exposure during pregnancy suggests that buprenorphine can besafely continued through antenatal period (c.f., Johnson et al., 2003).Buprenorphine appears to provide similar benefits (i.e., suppression ofopioid withdrawal symptoms, decreased illicit opioid use, stabliization ofthe intrauterine environment) to the mother as methadone but may beassociated with a qualitatively and quantitatively different neonatalabstinence syndrome (NAS) form that observed with mu-opioid agonists(Auricombe et al., 1999). This, well-controlled studies are needed toaddress critical questions regarding fetal and neonatal exposure tobuprenorphine and its metabolities to determine the impact of prenatalexposure.This symposium provided the latest laboratory and clinical data regardingprenatal exposure to buprenorphine. Specifically, Dr Ahmed reviews theplacental transfer and metabolism of buprenorphine compared to LAAM(another opioid agonist medication) and discusses the effect ofbuprenorphine and LAAM on placental viability and functional parameters.Dr Fischer reviewed case reports and prospective studies describingclinical outcomes of neonates following prenatal exposure tobuprenorphine. She provided data from two women who were maintained onbuprenorphine at conception and were prospectively followed. She reportedpreliminary data from double-blind, double dummy methadone versusbuprenorphine comparison. Dr. Finnegan discussed perinatal addiction withspecial attention given to prenatal opioid exposure and outcomes oftreatment with methadone versus buprenorphine. Suggestions for futureresearch needs were outlined.Placenta Transfer and Metabolism of Buprenorphine - M S AhmedNeonatal Outcome After Buprenorphine Treatment: Clinical andPharmacokinetic Features - G Fischer.